Image guidance methods and apparatus for glaucoma surgery

Abstract

An imaging probe comprises a camera or endoscope with an external detector array, in which the probe is sized and shaped for surgical placement in an eye to image the eye from an interior of the eye during treatment. The imaging probe and a treatment probe can be coupled together with a fastener or contained within a housing. The imaging probe and the treatment probe can be sized and shaped to enter the eye through an incision in the cornea and image one or more of the ciliary body band or the scleral spur. The treatment probe may comprise a treatment optical fiber or a surgical placement device to deliver an implant. A processor coupled to the detector can be configured with instructions to identify a location of one or more of the ciliary body band, the scleral spur, Schwalbe's line, or Schlemm's canal from the image.

What is claimed is: 
     
       1. An apparatus to treat an eye, comprising:
 a probe comprising an endoscope and a treatment element; and 
 a processor coupled to the probe, the processor configured with instructions to determine a position of a Schlemm's canal or an angular orientation of the treatment element, the position updating concurrent with movement of the probe; 
 wherein the treatment element comprises an implant located near a distal end of the probe, the implant comprising a distal portion sized and shaped for insertion into the Schlemm's canal; 
 wherein the endoscope is configured to visualize the implant near the distal end of the probe and one or more of the Schlemm's canal, a ciliary body band, a scleral spur or a Schwalbe's line of the eye. 
 
     
     
       2. The apparatus of  claim 1 , wherein the processor is configured with instructions to determine a location of the Schlemm's canal in response to an image of one or more of a ciliary body band or a scleral spur or a Schwalbe's line of the eye. 
     
     
       3. The apparatus of  claim 1 , wherein a processor is configured with instructions to determine a location of a trabecular meshwork in response to an image of one or more of the ciliary body band, the scleral spur, or the Schwalbe's line of the eye. 
     
     
       4. The apparatus of  claim 1 , wherein the endoscope comprises a lens, and further comprising a fiber optic array coupled to the lens to transmit an image to an array detector, the array detector comprising a plurality of rows and columns. 
     
     
       5. The apparatus of  claim 1 , wherein the processor is configured with one or more of a convolutional neural network, a machine learning algorithm or an edge detection algorithm to identify the one or more of the ciliary body band, the scleral spur or the Schwalbe's line and determine the angular orientation. 
     
     
       6. The apparatus of  claim 1 , wherein the processor is configured with instructions to display a boundary of the ciliary body band on a display. 
     
     
       7. The apparatus of  claim 1 , wherein the processor is configured with instructions to display a boundary of the scleral spur on a display. 
     
     
       8. The apparatus of  claim 1 , further comprising an array detector comprising an image of the Schwalbe's line formed thereon and wherein the processor is configured with instructions to determine a location of the Schwalbe's line in response to the image. 
     
     
       9. The apparatus of  claim 1 , wherein an image on one or more of a detector or an array detector comprises a visible image of the Schlemm's canal, and the processor is configured with instructions to determine a location of the Schlemm's canal in response to the visible image of the Schlemm's canal. 
     
     
       10. The apparatus of  claim 1 , wherein the processor is configured with instructions to determine a location of the Schlemm's canal in response to the one or more of the ciliary body band, the scleral spur or the Schwalbe's line and to display the location on a subsequent image from one or more of a detector or an array detector, the subsequent image updating concurrent with movement of probe. 
     
     
       11. The apparatus of  claim 1 , wherein the probe comprises a maximum dimension across within a range from 0.5 mm to 3 mm. 
     
     
       12. The apparatus of  claim 11 , wherein the probe comprises the maximum cross-sectional dimension over a longitudinal distance within a range from 10 mm to 50 mm, to access a trabecular meshwork of the eye and engage the trabecular meshwork. 
     
     
       13. The apparatus of  claim 1 , further comprising an inserter housing and a camera housing enclosing a camera with a fixed rotational orientation, the inserter housing enclosing one or more one or more movable components coupled to the implant. 
     
     
       14. The apparatus of  claim 1 , wherein the distal end of the probe extends beyond a distal most lens of the endoscope by a distance within a range from about 2 mm to about 10 mm and wherein the distance is dimensioned to visualize a portion of the distal end of the probe in an image of the one or more of the ciliary body band, the scleral spur or the Schwalbe's line. 
     
     
       15. The apparatus of  claim 1 , wherein an array detector is located a distance from the distal end of the probe, the distance within a range from about 2.5 mm to about 10.5 mm. 
     
     
       16. The apparatus of  claim 1 , further comprising an external sensor array located outside the eye and coupled to the endoscope to capture one or more images of the eye.